Inflation-deflation method for endoscopic evacuation of intracerebral haematoma

Nagasaka, Tetsuo; Inao, Suguru; Ikeda, Hiroshi; Tsugeno, Masanori; Okamoto, Takeshi

doi:10.1007/s00701-008-1561-6

Cited by 32 publications

(22 citation statements)

References 9 publications

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“…Due to the improvement of neuroendoscopic systems and instruments, recent series have shown high rates of hematoma evacuation that ranged from 83.4% to 99%. 3,4,[8][9][10]12 The hematoma evacuation rate in the present study is comparable to what has been reported in the literature. We do think that there is a trend toward a higher evacuation rate when the surgery is performed early (within 12 hours) due to the fact that, within this period, the clot is usually easily suctioned (in contrast to the treatment of subacute hematomas).…”

Section: Outcome Improvement With Early and Complete Hematoma Evacuationsupporting

confidence: 81%

“…It also avoids the early collapse of the hematoma cavity with residual hematoma that may need the inflation-deflation method to solve this problem. 8 The selection of the approach (the frontal or temporal approach) for putaminal ICH is an important issue. Hsieh et al 4 mentioned that, in patients with ICH volume less than 50 ml, it is not difficult to evacuate the hematoma through the shortest distance from the cortical surface to the hematoma.…”

Section: Comparison With Different Methods Of Endoscope-assisted Ich mentioning

confidence: 99%

“…1,3,4,[8][9][10][11][12][13][14] Table 2 summarizes the surgical indications, timing, technique, and results of the endoscope-assisted methods of ICH evacuation as reported in different series.…”

Section: Comparison With Different Methods Of Endoscope-assisted Ich mentioning

confidence: 99%

“…This is the so-called "wait-and-see saline irrigation" method that is a basic technique of neuroendoscopic surgery. If this does not stop the bleeding, the bleeder must be identified using the balanced irrigation-suction technique, which is elegantly described by Nagasaka et al 8 With constant irrigation and point suction, the bleeder can usually be identified. The bleeder is then meticulously caught and held by the suction cannula under low-pressure suction.…”

Section: Surgical Technique Caveat and Management Of Intraoperativementioning

confidence: 99%

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Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results

Kuo

Chen²,

et al. 2011

FOC

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Object Currently, the effectiveness of minimally invasive evacuation of intracerebral hemorrhage (ICH) utilizing the endoscopic method is uncertain and the technique is considered investigational. The authors analyzed their experience with this method in terms of case selection, surgical technique, and long-term results. Methods The authors performed a retrospective analysis of the clinical and radiographic data obtained in 68 patients treated with endoscope-assisted ICH evacuation. Rebleeding, morbidity, and mortality were recorded as primary end points. Hematoma evacuation rate was calculated by comparing the pre- and postoperative CT scans. Glasgow Coma Scale scores and scores on the extended Glasgow Outcome Scale (GOSE) were recorded at the 6-month postoperative follow-up. The technical aspect of this report explains details of the procedure, the instruments that are used, the methods for hemostasis, and the role of hemostatic agents in the management of intraoperative hemorrhage. The pertinent literature was reviewed and summarized. Results All surgeries were performed within 12 hours of ictus, and 84% of the surgeries were performed within 4 hours. The mortality rate was 5.9%, and surgery-related morbidity occurred in 3 cases (4.4%). The hematoma evacuation rate was 93% overall—96% in the putaminal group, 86% in the thalamic group, and 98% in the subcortical group. The rebleeding rate was 1.5%. The mean operative time was 85 minutes, and the average blood loss was 56 ml. The mean GOSE score was 4.9 at 6-month follow-up. The authors acknowledge the limitations of these preliminary results in a small number of patients. Conclusions The data suggest that early endoscope-assisted ICH evacuation is safe and effective in the management of supratentorial ICH. The rebleeding, morbidity, and mortality rates are low compared with rates reported in the literature for the traditional craniotomy method. This study also showed that early and complete evacuation of ICH may lead to improved outcomes in selected patients. However, the safety and efficacy of endoscope-assisted ICH evacuation should be further investigated in a large, prospective, randomized trial.

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Section: Outcome Improvement With Early and Complete Hematoma Evacuationsupporting

confidence: 81%

Section: Comparison With Different Methods Of Endoscope-assisted Ich mentioning

confidence: 99%

Section: Comparison With Different Methods Of Endoscope-assisted Ich mentioning

confidence: 99%

Section: Surgical Technique Caveat and Management Of Intraoperativementioning

confidence: 99%

See 2 more Smart Citations

Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results

Kuo

Chen²,

et al. 2011

FOC

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“…The last decade has brought significant advances in endoscopic surgical instruments and techniques that have improved patient outcomes (12,16,20). Recent reports on the rate of hematoma evacuation through endoscopic surgery have reached rates of 99% (15,17), and comparative studies about minimally invasive surgery and craniotomy are still rare. We believe that as long as the positioning is accurate, keyhole endoscopic surgery can achieve the effect of large craniotomy surgery.…”

Section: Endoscopic Surgerymentioning

confidence: 99%

Keyhole endoscopic hematoma evacuation in patients

Zhu¹,

Wang²,

Shi³

2011

Turkish Neurosurgery

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AIm: Keyhole endoscopy is a promising therapeutic option for spontaneous intracerebral hemorrhage (ICH). We sought to compare the clinical outcomes between keyhole endoscopy surgery and craniotomy for basal ganglia ICH. mAteRIAl and methods:The authors performed a retrospective analysis of the clinical and radiographic data obtained in 28 keyhole endoscopic procedures and 30 craniotomy procedures. Hematoma evacuation rate, infection rate, rebleeding and mean operation time were recorded as primary end points. Outcome Scale (GOS) values were recorded at the 3-month postoperative follow-up. The operation time from symptom onset is also studied between <8 hours group and 8-24 hours group. Results:The evacuation rate was significantly higher in the endoscopy group compared with the craniotomy group (P<0.05), and infectious rate was lower in the endoscopy group compared with the craniotomy group( P<0.05). Mortality rates between the 2 groups did not show statistically significant differences. The patients operated within 8h had better outcome (GOS 4 and 5) than that operated between 8-24h (p <0.05). ConClusIon:The data indicate that in patients with ICH, keyhole endoscopic surgery is safe and feasible, while operation within 8h can promote recovery of patients. These preliminary results warrant further study in a large, prospective, randomized trial in the near future.KeywoRds: Keyhole endoscopy, Intracerebral hemorrhage, Operation timing, Minimally invasive surgery ÖZ AmAÇ: Anahtar deliği endoskopisi spontan intraserebral kanama (İSK) için ümit verici bir terapötik seçenektir. Bazal gangliada İSK için anahtar deliği endoskopi cerrahisi ve kraniyotomi arasında klinik sonuçları karşılaştırmak istedik. yÖntem ve GeReÇleR: Yazarlar 28 anahtar deliği endoskopik işlem ve 30 kraniyotomi işleminde elde edilen klinik ve radyografik verilerin retrospektif bir analizini yapmışlardır. Hematom boşaltma oranı, enfeksiyon oranı, tekrar kanama ve ortalama ameliyat süresi primer son noktalar olarak kaydedildi. Sonuç Ölçeği (GOS) değerleri 3 aylık postoperatif takipte kaydedilmiştir. Semptom başlangıcından operasyon süresi de <8 grup ve 8-24 saatlik grup olarak çalışılmıştır.BulGulAR: Boşaltma oranı endoskopi grubunda kraniyotomi grubuna göre anlamlı ölçüde daha yüksektir (P<0,05) ve enfeksiyon oranı endoskopi grubunda kraniyotomi grubundan daha düşüktür ( P<0,05). 2 grup arasındaki mortalite oranı istatistiksel olarak anlamlı farklılıklar göstermemiştir. 8 saat içinde ameliyat edilen hastaların sonuçları (GOS 4 ve 5) 8-24 saat arasında ameliyat edilenlerden daha iyidir (p <0,05). sonuÇ: Veriler İSK hastalarında anahtar deliği endoskopik cerrahinin güvenli ve kabul edilebilir olduğunu ve 8 saat içinde yapılan ameliyatın hastaların iyileşmesini desteklediğini göstermiştir. Bu ön sonuçların yakın gelecekte geniş, prospektif, randomize bir çalışmada daha ileri değerlendirilmesi gerekir.

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